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PSA Concern while on AS

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Posted 3/15/2015 2:25 PM (GMT 0)
I have been on AS for three years now being followed by a Dr. at Memorial Sloan Kettering. My PSA (most recent 6.3) has risen about 1 point a year and my Dr. doesn't seem phased by the increase. Since it is MSKCC should I have more faith in my Dr. opinion? Are others on AS seeing an increase in PSA over time?
Posted 3/15/2015 3:02 PM (GMT 0)
In my case, my PSA climbed from 3.4 to 9.6, even though, at the end, I had Gleason 6 with low volume. Sometimes, such tumors appear to generate higher PSA even though they seem to be insignificant. The tumors found via a TURP were all in the transition zone, discovered incidentally.

By the way, the biopsy involved 25 grams of prostate tissue, not your ordinary 12 cores extracted via a needle TRUS biopsy. Once these tumors were removed, my PSA has dropped to 0.9 in the last test.

Posted 3/15/2015 3:05 PM (GMT 0)
I'd follow your doctor's lead on this.

an increase over time would be somewhat normal.

The real question in my mind would be, when does it move from just needing to be watched to needing to be treated. That's the conversation I'd be having with the doctor.
Andrew
Posted 3/15/2015 3:19 PM (GMT 0)
tooyoung,

I want to add that most AS programs nowadays do not rely on PSA velocity to move patients to active treatment. I would rely a lot more on the Gleason score and the total tumor volume.

In my case, I was not treated for the first 13 years my PSA gave suspicious signals because the 3 biopsies searching for the cancer turned out negative. Given that back in the early 2000s, AS was not so prevalently used, I lucked out because there is no doubt in my mind that I would have undergone a radical surgery (I didn't know anybody in my location who treated PCa any other way) no matter how insignificant the cancer that was found in the biopsy.
Posted 3/15/2015 6:12 PM (GMT 0)
Andrew, That was the questions I ask my Dr., is it time to treat? His comment was "no, we'll do another MRI in August and if it shows something we can do another biopsy" If it wasn't MSKCC I would probably go for a second opinion. MSKCC is modifying there program from a MRI and biopsy every two years to a MRI every 18 months and biopsy every three years.
Posted 3/15/2015 6:44 PM (GMT 0)
I wonder if it is a change in benign tissue.
Could you track your PSA density, PSA divided by prostate volume?
Posted 3/15/2015 9:15 PM (GMT 0)
So you can do AS with a Psa that high
Posted 3/15/2015 9:54 PM (GMT 0)
RobertC, My prostate was 30 cc last year. It will be interesting to see what it is at my next MRI in August.

CVC, usually you can be in a AS program if your PSA is below 10. With your PSA value at 1.16 what makes you think you have PC?
Posted 3/15/2015 10:21 PM (GMT 0)
I didnt say I thought I had Pc......I dont think I do...I do keep an eye on my psa though and I was just asking a ?
Posted 3/15/2015 11:10 PM (GMT 0)

toyoung said...
Andrew, That was the questions I ask my Dr., is it time to treat? His comment was "no, we'll do another MRI in August and if it shows something we can do another biopsy" If it wasn't MSKCC I would probably go for a second opinion. MSKCC is modifying there program from a MRI and biopsy every two years to a MRI every 18 months and biopsy every three years.

I like your doctor. Keep him. Sound advice in my opinion.

Andrew
Posted 3/16/2015 1:52 AM (GMT 0)
I am not your doctor, nor pretending to be one, but if I read correctly, you have had 3 biopsies, and only on the first, did you have a single positive G6 core, is this correct?

If so, despite, the rising PSA, if your nerves are steady, AS still seems appropriate to me. Especially since the last one came back with no positive cores.

I am thinking, when and if your doctor feels is appropriate, the worse that would happen is to have another biopsy at some point, and see if any cancer is evidence, and to what grade and extent it is.

I had the opposite of you. I had 3 biopsies spread over 18 months. First negative, some PIN. Second negative, lots of HGPIN and a suspicious area. Third one, 7 of 7 positive, Gleason 7, up to 90%. In my case, the first 2 biopsies simply missed the cancer, plain and simple.

Sounds like you are in good hands, hope you feel that way
Posted 3/16/2015 5:29 AM (GMT 0)
Well Toyoung I hope you are wiser now. I'm not. Am also on AS and the PSA scores seem to be all we have to go on, as well as biopsy's of coarse...and they tell us that the PSA scores are hit and miss. i am very confused about it. i like certainty especially when to comes to my health. It seems the PSA scores are a bit like a baseball umpire...it is what he calls it. In the case of PSA scores it's what your Dr. calls it...unless of coarse surgery or a biopsy says different.
I suspect, and this may sound way out in left field...that our PSA scores are peculiar to us. What is high and significant for one of us may be normal for someone else. Just throwing it out there. If anyone feels the need to contradict feel free. I would welcome being straightened out, but bear in mind i am a sensitive soul, so do it in a kind and loving way if you can.
Posted 3/16/2015 11:56 AM (GMT 0)

Bald, you said...
I suspect, and this may sound way out in left field...that our PSA scores are peculiar to us. What is high and significant for one of us may be normal for someone else.


No, not out of left field. You are quite right. There are a large number of variables that contribute to PSA scores, most of which have nothing to do with prostate cancer, and even that part of the PSA score that is caused by prostate cancer is complicated since the higher-Gleason tumors -- the more aggressive cancers -- tend to produce less PSA per gram of tumor than do less aggressive cancers. That's why there is more to Active Surveillance than just watching the PSA.
Posted 3/16/2015 6:01 PM (GMT 0)
tooyoung,

Have you used the MSKCC doubling time calculator?

http://www.mskcc.org/nomograms/prostate/psa-doubling-time

I entered the data you listed...your doubling time is 6+ years, doesn't seem too far from normal prostate aging processes.
Posted 3/16/2015 7:31 PM (GMT 0)
PeterDisAbelard, It's situations like yours that make me nervous. After 4 biopsies they only found 1 core Gleason 6 (or 7) but the pathology report showed Gleason 9. Did you ever consider AS after your 4 biopsies? What made you decide to treat?

NKinny, The 5.3 on 2/2012 skews the data. It appears my PSA didn't increase much in 2013 then started to accelerate. If I start the calculations from 08/01/2013 to present the doubling time is 33 months.
Posted 3/17/2015 4:54 AM (GMT 0)
toyoung,

I have been on AS for over five years since I was diagnosed at age 54. It has risen steadily from 3.9 to somewhere close to 8.0 and up and down again several times. I'm under the care of Dr. Scholz in Marina del Rey and he isn't greatly concerned about the fluctuations in my numbers. He attributes my rising numbers to the rather large size of my prostate. I believe it's around 72cc.

I have a Lesion-directed biopsy using Color Doppler Ultrasound and an Endorectal MRI directed biopsy once a year to monitor my tumor which has remained the same size during the last five years.
Posted 3/17/2015 5:25 AM (GMT 0)

Franchot said...
toyoung,

I have been on AS for over five years since I was diagnosed at age 54. It has risen steadily from 3.9 to somewhere close to 8.0 and up and down again several times. I'm under the care of Dr. Scholz in Marina del Rey and he isn't greatly concerned about the fluctuations in my numbers. He attributes my rising numbers to the rather large size of my prostate. I believe it's around 72cc.

I have a Lesion-directed biopsy using Color Doppler Ultrasound and an Endorectal MRI directed biopsy once a year to monitor my tumor which has remained the same size during the last five years.

Do you have a biopsy every year?
Posted 3/18/2015 5:43 AM (GMT 0)

island time said...
Do you have a biopsy every year?

The first biopsy (needle samples) I had diagnosed my cancer. I waited about two years for the second one. (Again needle samples.) (It showed no progression of cancer growth.) The last one I had was the 3T MRI (which is non-needle.)

Currently, I am doing the 3T MRI and Color Doppler biopsies once a year.
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